| NPI | 1952684169 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA de60243125) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D9596) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2011-10-06 |